The present invention relates to a method of producing an intra-ocular lens or a contact lens.
Intra-ocular lenses (IOLs) are artificial eye lenses consisting e.g. of acrylic glass, in particular xe2x80x9cPlexiglasxe2x80x9d, or polymethyl methacrylate (PMMA), in particular in the form of a material offered under the name of Acrysoft (trademark). Also silicone is used as a material for IOLs.
Intra-ocular lenses serve to correct refractive errors of the eye, often after a removal of the natural lens. IOIs are also used for correcting high-order visual defects. Also for remedying aphakia IOLs are becoming increasingly important.
The implantation of an IOL is a microsurgical operation carried out either in one session (primary implantation) or in more than one session with insertion of the lens into the apha-kial eye.
Hundreds of different types of intra-ocular lenses are known. These lenses are normally roughly classified according to the positioning of the IOL and its fixation in the eye. A distinction is made between xe2x80x9canterior chamber lensesxe2x80x9d; xe2x80x9ciris clip lensesxe2x80x9d; xe2x80x9cposterior chamber lenses fixed in the sulcus (posterior chamber angle)xe2x80x9d; and xe2x80x9cposterior chamber lenses fixed in the capsular sacxe2x80x9d. The present invention relates in particular to all these intra-ocular lenses.
Furthermore, the present invention also relates to contact lenses, i.e. optical lenses acting as a visual aid in contact with the eye. A contact lens is optimally adapted to the individual shape of the front section of the eye with its inner surface facing the eye. It serves to correct visual defects and irregular refractive errors, normally refractive errors of the cornea of the eye. Materials which are adapted to be used for contact lenses are in particular PMMA and modifications thereof, CAB (cellulose acetobutyrate), silicone methacrylates, fluorosilicone acrylates, fluorocarbons, HEMA hydrogels, etc.
In the prior art, intra-ocular lenses as well as contact lenses are normally formed at the manufacturer""s, then delivered to the hospital or the ophthalmologist where they are inserted in or attached to the patient""s eye, i.e. the lenses are mechanically formed and, optionally, polished, packed in a sterile condition and then delivered to the hospital or the ophthalmologist who inserts the respective lens in the patient""s eye.
Intra-ocular lenses especially serve to correct myopia, hyperopia, and astigmatism. For this purpose, the so-called refraction data of the patient""s eye are measured, i.e. the dioptric value measured for the patient""s eye determines the shape of the lens. In accordance with this measurement, the ophthalmologist then orders or takes from a stock a specific intra-ocular lens corresponding to this dioptric value of the patient. It follows that this conventional method is in this sense an xe2x80x9coverall correctionxe2x80x9d of lower-order visual defects insofar as the correction is based on the xe2x80x9coverallxe2x80x9d dioptric value of the eye.
Optical image formation in the eye is, however, not only impaired by the above-mentioned lower-order visual defects but also by so-called higher-order image errors. Such higher-order image errors occur especially after operations on the cornea and within the eye (cataract operations). Such optical aberrations may be the cause for the fact that, in spite of a medical correction of lower-order defects, the full visus is not achieved. P.Mierdel, H.-E. Krinke, W. Wigand, M. Kaemmerer and T. Seiler describe in xe2x80x9cDER OPHTHALMOLOGExe2x80x9d, No. 6, 1997, p. 441, a measuring set-up for determining the aberration of the human eye. By means of such a measuring set-up, aberrations (imaging errors) for monochromatic light can be measured. The aberrations that can be measured are not only aberrations caused by the cornea, but what can be measured are the imaging errors caused by the whole ocular image-forming system of the eye, said measurements being carried out in a position-dependent manner, i.e. for given locations within the pupil of the eye it can be determined with a specific resolution how large the imaging error of the whole optical system of the eye to be corrected is at this location. Such imaging errors of the eye are mathematically described in the above-cited paper of P. Mierdel et al. as so-called wave-front aberration. A wave-front aberration is the three-dimensional profile of the distance between a real light wave front of a central spot of light and a reference surface, e.g. an ideal spherical shape, i.e. the system used as a spatial reference system is e.g. the spherical surface of the ideal wave front. It is, in principle, also known in the prior art to choose a plane as a reference system for the aberration measurement, in cases in which the ideal wave front to be measured is flat.
When realizing the present invention, the measurement principle according to the above-mentioned paper of P. Mierdel, T. Seiler et al. can also be used as an initial step. The essential features here are that a parallel bundle of light of sufficient diameter is subdivided into separate parallel single rays by a perforated mask. These single rays pass through a collective lens (a so-called aberroscope lens) and are thus focussed in front of the retina at a specific distance therefrom in the case of an emmetropic eye. This leads to easily visible projections of the mask holes on the retina. This retinal light spot pattern is imaged on the sensor area of a CCD video camera according to the principle of indirect ophthalmoscopy. In the aberrationfree ideal eye the imaged light spot pattern is orthoscopic and corresponds precisely to the perforated mask pattern. If, however, an aberration exists, this will result in individual displacements of each pattern spot, since each single ray passes through a specific area of the cornea and pupil, respectively, and undergoes a deviation from the ideal path in accordance with the irregular optical effect. From the retinal pattern spot displacements, the wave-front aberration is finally determined with an approximation method as a local function over the pupil area. The above-cited prior art also describes the mathematical representation of this wave-front aberration in the form of a so-called xe2x80x9cwave-front aberration mountainxe2x80x9d. This wave-front aberration mountain indicates over each pupil location (x-y coordinates) a value for the wave-front aberration W(x, y) which is then plotted as height against the x-y coordinates. The higher the xe2x80x9cmountainxe2x80x9d, the higher the imaging distortions in the eye at the respective pupil location. For each incident light beam there is a proportionality between the measured deviation of the respective retinal light spot from its ideal position and the steepness of the xe2x80x9cwave-front aberration mountainxe2x80x9d in a first approximation. It follows that the wave-front aberration can be determined therefrom as a local function related to an arbitrary reference value on the optical axis of the system. Ideal, normally undistorted light spot positions on the retina, which can provide the reference value, are e.g. four central, closely spaced spots. Such spots represent a central cornea-pupil zone having a diameter of approx. 1 to 2 mm; from previous experience, it can be assumed that this zone is largely free from higher-order image errors.
The xe2x80x9cwave-front aberration mountainxe2x80x9d can be mathematically represented in different ways with the aid of a complete term (a function). Terms which can be used for this purpose are e.g. approximations in the form of a sum of Taylor polynomials or especially also Zernike polynomials. The Zernike polynomials have the advantage that their coefficients are directly related to the generally known image errors (spherical aberration, coma, astigmatism, distortion). The Zernike polynomials are a set of fully orthogonal functions. In a paper of J. Liang, B. Grimm, S. Goelz and J. F. Bille, xe2x80x9cObjective measurement of wave aberrations of the human eye with the use of a Hartmann-Shack wave-front sensor, Optical Society of America, 11(7): 1949-1957, July 1994, it is shown how the wave front (or rather the wave-front aberration) can be calculated from the grid-point displacements. The actual wave front can be determined in this way from the determination of the derivative function of the wave front. The wave front is obtained as solution of a system of equations. Also the paper of H. C. Howland and B. Howland xe2x80x9cA Subjective Method for the Measurement of Monochromatic Aberrations of the Eyexe2x80x9d, Journal of the Optical Society of America, 67(11): 1508-1518, November 1977, describes a method of determining the monochromatic aberration and the determination of the first fifteen Taylor coefficients. This prior art can be resorted to.
In WO 99/27334 the wave-front aberration of the eye is measured and used for the subsequent ablation.
The prior art also describes the attempt to determine ablation profiles individually, in a position-dependent manner, for an eye to be corrected, said determination being based on so-called topographic measurements of the cornea surface, cf. C. E. Martinez, R. A. Applegate et al. in ARCH OPHTHALMOL/Vol. 116, August 1998, pp. 1053-1062. However, such topographies of the cornea surface only provide data on the corneal curvature, i.e. height data at each point of the cornea surface. While it is true that these data can be used for calculating aberrations, they only supply information on higher-order aberrations on the cornea surface, without providing aberration values for the whole optical system xe2x80x9ceyexe2x80x9d. The visual discrimination of the eye (visus) is, however, not only determined by the cornea surface but by the whole optical system of the eye to be corrected (e.g. also the crystalline lens) so that an improvement is desirable also insofar.
It is the object of the present invention to provide a method for economically producing intra-ocular lenses and contact lenses in the case of which the lenses also take into account individual higher-order aberrations of the eye.
Methods according to the present invention by means of which this object can be achieved are characterized in the independent claims.
According to the present invention, a so-called lens blank is first produced mechanically in a conventional manner. The term xe2x80x9cmechanicalxe2x80x9d should here comprise all manufacturing methods which are not based on the ablation (removal) of material by means of laser radiation. The lens blanks can e.g. be cast, pressed or mechanically formed in some other way and, optionally, they can be polished subsequently. This forming of the lens blank takes place such that the lens blank is designed in accordance with an overall dioptric value of the eye to be corrected, e.g. according to the measured dioptric value of the eye, without taking into account higher-order aberrations of the eye, like those that can be determined by the above-described measurement of the wave-front aberration. Such lens blanks can then be delivered by the manufacturer to the site where they are to be used, e.g. hospitals and ophthalmologists, in a sterile type of packing.
On site, i.e. at the hospital or ophthalmological practice, the wave-front aberration of the whole optical system of the eye to be corrected can then be measured with an aberroscope according to a further step of the present invention. This measurement determines individual refractive properties of the eye, in dependence upon the location within the pupil, thus permitting further processing of the lens blank obtained in the manner described hereinbefore, so as to take into account higher-order aberrations of the eye, by subjecting the lens blank on site to further processing in accordance with the measured aberration data. A system which is particularly suitable for such further processing of the lens blank is a laser system which is available at the hospital or ophthalmological practice anyhow and which is normally used for other purposes, e.g. for shaping the cornea, (e.g. PRK, in particular LASIK). Such laser systems emit wavelengths which can be used for re-shaping not only the cornea of the eye by a removal of material (ablation) but, to a large extent, they can also be used for re-shaping lens material for the above-explained intra-ocular lenses or contact lenses. The invention can also be used by opticians who possess a suitable laser system, i.e. the optician obtains the lens blank and subjects it to further processing according to the present invention.
The data of the individual eye to be corrected, which have been obtained by the measurement of the wave-front aberration, are inputted in a computer; so are the data of the lens blank which, as has already been stated, has been prepared for the correction of an ametropic visual defect, e.g. myopia, hyperopia or astigmatism.
The computer is then programmed in such a way that it calculates on the basis of the two data of the above-mentioned type (i.e. data of the lens blank on the one hand and data of the measurement of the wave-front aberration on the other) an ablation profile with respect to the given lens blank, i.e. it calculates a further shaping of the lens blank in such a way that, after having been inserted in or attached to the eye, the lens body, which has been subjected to suitable further shaping by means of laser radiation, will largely correct the lower-order aberrations (myopia, hyperopia or astigmatism) as well as the individual higher-order aberrations of the eye, i.e. local refractive properties of the xe2x80x9coverall systemxe2x80x9d eye with irregular optical effects.
The ablation of material of the lens blank by means of laser radiation takes place remote from the patient""s eye, i.e. not in a condition in which the lens is inserted in or attached to the eye.
It is also possible to calculate in the step of calculating the ablation profile not only the ablation profile with regard to the lens blank but also a further ablation profile, viz. an ablation profile concerning the cornea of the eye into which the lens is to be inserted or to which the lens is to be attached. According to this variant of the invention, an intra-ocular lens or a contact lens is obtained, which carries out part of the correction, whereas the rest of the correction is effected by re-shaping the cornea (again by means of laser radiation). For the latter shaping of the cornea, conventional techniques are available, especially LASIK. The lens shaped in this way can be inserted into the eye before or after the ablation of cornea material.
The fact that the present invention is so conceived that the production is divided firstly into a standardized lens blank and, secondly, into an xe2x80x9cafter-treatmentxe2x80x9d of this lens blank with laser radiation on site at the hospital, the ophthalmological practice or at the optician""s has the advantage that the production of the lens, which is finally inserted into the eye, is substantially simplified (and therefore much less expensive). Stockkeeping for the hospital or the practice is substantially simplified as well.